Endoscopic surgery encompasses surgery on various parts of the body requiring only small incisions or portals for insertion of surgical instruments through an access tube (e.g., a cannula) and manipulated externally of the body. Endoscopic surgery is preferable over open surgery to avoid trauma associated with large incisions as well as hospitalization and prolonged recovery periods associated with open surgery. Endoscopic surgery is used whenever possible to achieve the same results as open surgery without the aforementioned disadvantages thereof.
Recently, laparoscopic cholecystectomy has become a popular surgical procedure since it involves the same procedure as an open cholecystectomy (using different surgical instruments) with, however, the benefits of better visualization and less patient morbidity. Hernia repair represents another surgical procedure that could be conducted as an endoscopic procedure rather than an open procedure. However, to date, widespread laparoscopic repair of direct and indirect inguinal hernias has been hampered by the inability to suture through the cannula in an expeditious manner.
The Caspari et al U.S. Pat. Nos. 4,890,615 and 4,923,461 describe an arthroscopic suturing instrument including a pair of relatively movable jaws for clamping tissue while a hollow needle on one of the jaws is actuated to penetrate the tissue and is then received in an aperture in the other of the jaws. A suture feed mechanism is provided to feed suture material through the hollow needle and the aperture. The jaws are then opened, and the instrument withdrawn from the body through a cannula to pull the free end of the suture material out of the body so that the surgeon can tie a suitable extracorporal knot in the suture material. The knot is then moved into the body through the cannula to a position proximate the sutured tissue by a conventional throw stick, and the surgeon tightens the knot by pulling on either or both ends of the suture material remaining outside the body.
The Southerland et al U.S. Pat. No. 2,316,297 disclosures a surgical instrument for facilitating the tying of blood vessels and arteries, particularly in throat operations. The instrument includes a pair of relatively movable jaws operable to clamp an artery after a suture has been loosely tied thereabout. The free ends of the suture are passed through slots in a slidable, jaw-locking barrel, through an eyelet on the barrel, and then secured in a clip on the barrel after the suture is loosely tied. The barrel is then slid over the jaws to lock them in the clamped position. The ends of the suture are then removed from the clip and a steady pull is exerted thereon to cause the knot to tighten around the artery. A short tube mounted on the barrel is manually slid over the barrel to cut the ends of the suture at each side of the tightened knot.